The Safety and Efficacy of Flow Diversion versus Conventional Endovascular Treatment for Intracranial Aneurysms: A Meta-analysis of Real-world Cohort Studies from the Past 10 Years.

Abstract

Although the flow diverter has advantages in the treatment of intracranial aneurysms, pooled studies that directly compare it with conventional endovascular treatments are rare. Our aim was to compare the safety and efficacy of flow-diverter and conventional endovascular treatments in intracranial aneurysms. We performed a comprehensive search of the literature using PubMed, EMBASE, and the Cochrane Database. We included only studies that directly compared the angiographic and clinical outcomes of flow-diverter and conventional endovascular treatments. Random effects or fixed effects meta-analysis was used to pool the cumulative rate of short- and long-term angiographic and clinical outcomes. Eighteen studies with 1001 patients with flow diverters and 1133 patients with conventional endovascular treatments were included; 1015 and 1201 aneurysm procedures were performed, respectively. The flow-diverter group had aneurysms of a larger size (standard mean difference, 0.22; 95% CI, 0.03-0.41; P = .026). There was a higher risk of complications in the flow-diverter group compared with the conventional endovascular group (OR, 1.4; 95% CI, 1.01-1.96; P = .045) during procedures. The follow-up angiographic results of flow-diverter treatment indicated a higher rate of complete occlusion (OR, 2.55; 95% CI, 1.70-3.83; P < .001) and lower rates of recurrence (OR, 0.24; 95% CI, 0.12-0.46; P < .001) and retreatment (OR, 0.31; 95% CI, 0.21-0.47; P < .001). Limitations include a retrospective, observational design in some studies, high heterogeneity, and selection bias. Compared with the conventional endovascular treatments, the placement of a flow diverter may lead to more procedure-related complications, but there is no difference in safety, and it is more effective in the long term.